End effector for a positioning device

ABSTRACT

An end effector is provided for connecting to a positioning arm of a positioning device of a medical navigation system. The end effector comprises a mating component for connecting to an output flange of the positioning arm, a handle portion having a first end and a second end, the first end extending from the mating component, the handle portion including a cable cut-out at the first end, and a camera mount connected to the second end of the handle portion.

TECHNICAL FIELD

The present disclosure is generally related to image guided medicalprocedures, and more specifically to an end effector for a medicalprocedure positioning device employing a dynamic positioning system.

BACKGROUND

The present disclosure is generally related to image guided medicalprocedures using a surgical instrument, such as an optical scope, anoptical coherence tomography (OCT) probe, a micro ultrasound transducer,an electronic sensor or stimulator, or an access port based surgery.

In the example of a port-based surgery, a surgeon or robotic surgicalsystem may perform a surgical procedure involving tumor resection inwhich the residual tumor remaining after is minimized, while alsominimizing the trauma to the intact white and grey matter of the brain.In such procedures, trauma may occur, for example, due to contact withthe access port, stress to the brain matter, unintentional impact withsurgical devices, and/or accidental resection of healthy tissue. A keyto minimizing trauma is ensuring that the surgeon performing theprocedure has the best possible view of the surgical site of interestwithout having to spend excessive amounts of time and concentrationrepositioning tools and cameras during the medical procedure.

FIG. 1 illustrates the insertion of an access port into a human brain,for providing access to internal brain tissue during a medicalprocedure. In FIG. 1, access port 12 is inserted into a human brain 10,providing access to internal brain tissue. Access port 12 may includesuch instruments as catheters, surgical probes, or cylindrical portssuch as the NICO Brain Path. Surgical tools and instruments may then beinserted within the lumen of the access port in order to performsurgical, diagnostic or therapeutic procedures, such as resecting tumorsas necessary. The present disclosure applies equally well to catheters,DBS needles, a biopsy procedure, and also to biopsies and/or cathetersin other medical procedures performed on other parts of the body.

In the example of a port-based surgery, a straight or linear access port12 is typically guided down a sulci path of the brain. Surgicalinstruments would then be inserted down the access port 12.

Optical tracking systems, used in the medical procedure, track theposition of a part of the instrument that is within line-of-site of theoptical tracking camera. These optical tracking systems also require areference to the patient to know where the instrument is relative to thetarget (e.g., a tumor) of the medical procedure. These optical trackingsystems require a knowledge of the dimensions of the instrument beingtracked so that, for example, the optical tracking system knows theposition in space of a tip of a medical instrument relative to thetracking markers being tracked. This enables a camera system thatfocuses on the surgical site of interest to display an image of thesurgical site on a monitor so that the surgeon can see the surgical siteat the end of the access port.

Conventional systems have not offered robust automated camera systemsthat maintain a field of view of the camera on the surgical site.Consequently, the choice of end effectors for robotic camera trackingsystems is limited. It would be desirable to have an end effector for amedical procedure positioning device that satisfies the needs ofoperating room in the context of the procedures mentioned above.

SUMMARY

One aspect of the present disclosure provides an end effector forconnecting to a positioning arm of a positioning device of a medicalnavigation system. The end effector comprises a mating component forconnecting to an output flange of the positioning arm, a handle portionhaving a first end and a second end, the first end extending from themating component, the handle portion including a cable cut-out at thefirst end, and a camera mount connected to the second end of the handleportion. The end effector may further have a mechanical interfacelocated at the second end of the handle portion and a scope clamp armconnected to the mechanical interface for clamping a scope.

Another aspect of the present disclosure provides a medical navigationsystem having a positioning device having a positioning arm with anoutput flange at the end of the positioning arm, a controller at leastelectrically coupled to the positioning device, the controller having aprocessor coupled to a memory and a display, and an end effectorconnected to the positioning arm of the positioning device. The endeffector comprises a mating component connected to the output flange, ahandle portion having a first end and a second end, the first endextending from the mating component, the handle portion including acable cut-out at the first end, and a camera mount connected to thesecond end of the handle portion.

A further understanding of the functional and advantageous aspects ofthe disclosure can be realized by reference to the following detaileddescription and drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

Embodiments will now be described, by way of example only, withreference to the drawings, in which:

FIG. 1 illustrates the insertion of an access port into a human brain,for providing access to internal brain tissue during a medicalprocedure;

FIG. 2 shows an exemplary navigation system to support minimallyinvasive access port-based surgery;

FIG. 3 is a block diagram illustrating a control and processing systemthat may be used in the navigation system shown in FIG. 2;

FIG. 4A is a flow chart illustrating a method involved in a surgicalprocedure using the navigation system of FIG. 2;

FIG. 4B is a flow chart illustrating a method of registering a patientfor a surgical procedure as outlined in FIG. 4A;

FIG. 5 is an exemplary navigation system similar to FIG. 2 illustratingsystem components of an exemplary surgical system used in port basedsurgery;

FIG. 6 is perspective drawing illustrating a conventional end effectorholding a camera;

FIG. 7 is a perspective drawing illustrating an end effector accordingto aspects of the present description;

FIG. 8 is another perspective drawing showing the end effector of FIG.7;

FIG. 9 is another perspective drawing showing the end effector of FIG. 7holding a camera and a videoscope; and

FIG. 10 is another perspective drawing showing the end effector of FIG.7 holding a camera and a videoscope and connected to an automated arm ofa positioning device.

DETAILED DESCRIPTION

Various embodiments and aspects of the disclosure will be described withreference to details discussed below. The following description anddrawings are illustrative of the disclosure and are not to be construedas limiting the disclosure. Numerous specific details are described toprovide a thorough understanding of various embodiments of the presentdisclosure. However, in certain instances, well-known or conventionaldetails are not described in order to provide a concise discussion ofembodiments of the present disclosure.

As used herein, the terms, “comprises” and “comprising” are to beconstrued as being inclusive and open ended, and not exclusive.Specifically, when used in the specification and claims, the terms,“comprises” and “comprising” and variations thereof mean the specifiedfeatures, steps or components are included. These terms are not to beinterpreted to exclude the presence of other features, steps orcomponents.

As used herein, the term “exemplary” means “serving as an example,instance, or illustration,” and should not be construed as preferred oradvantageous over other configurations disclosed herein.

As used herein, the terms “about”, “approximately”, and “substantially”are meant to cover variations that may exist in the upper and lowerlimits of the ranges of values, such as variations in properties,parameters, and dimensions. In one non-limiting example, the terms“about”, “approximately”, and “substantially” mean plus or minus 10percent or less.

Unless defined otherwise, all technical and scientific terms used hereinare intended to have the same meaning as commonly understood by one ofordinary skill in the art. Unless otherwise indicated, such as throughcontext, as used herein, the following terms are intended to have thefollowing meanings:

As used herein, the phrase “access port” refers to a cannula, conduit,sheath, port, tube, or other structure that is insertable into asubject, in order to provide access to internal tissue, organs, or otherbiological substances. In some embodiments, an access port may directlyexpose internal tissue, for example, via an opening or aperture at adistal end thereof, and/or via an opening or aperture at an intermediatelocation along a length thereof. In other embodiments, an access portmay provide indirect access, via one or more surfaces that aretransparent, or partially transparent, to one or more forms of energy orradiation, such as, but not limited to, electromagnetic waves andacoustic waves.

As used herein the phrase “intraoperative” refers to an action, process,method, event or step that occurs or is carried out during at least aportion of a medical procedure. Intraoperative, as defined herein, isnot limited to surgical procedures, and may refer to other types ofmedical procedures, such as diagnostic and therapeutic procedures.

Embodiments of the present disclosure provide imaging devices that areinsertable into a subject or patient for imaging internal tissues, andmethods of use thereof. Some embodiments of the present disclosurerelate to minimally invasive medical procedures that are performed viaan access port, whereby surgery, diagnostic imaging, therapy, or othermedical procedures (e.g. minimally invasive medical procedures) areperformed based on access to internal tissue through the access port.

Referring to FIG. 2, an exemplary navigation system environment 200 isshown, which may be used to support navigated image-guided surgery. Asshown in FIG. 2, surgeon 201 conducts a surgery on a patient 202 in anoperating room (OR) environment. A medical navigation system 205comprising an equipment tower, tracking system, displays and trackedinstruments assist the surgeon 201 during his procedure. An operator 203is also present to operate, control and provide assistance for themedical navigation system 205.

Referring to FIG. 3, a block diagram is shown illustrating a control andprocessing system 300 that may be used in the medical navigation system200 shown in FIG. 3 (e.g., as part of the equipment tower). As shown inFIG. 3, in one example, control and processing system 300 may includeone or more processors 302, a memory 304, a system bus 306, one or moreinput/output interfaces 308, a communications interface 310, and storagedevice 312. Control and processing system 300 may be interfaced withother external devices, such as tracking system 321, data storage 342,and external user input and output devices 344, which may include, forexample, one or more of a display, keyboard, mouse, sensors attached tomedical equipment, foot pedal, and microphone and speaker. Data storage342 may be any suitable data storage device, such as a local or remotecomputing device (e.g. a computer, hard drive, digital media device, orserver) having a database stored thereon. In the example shown in FIG.3, data storage device 342 includes identification data 350 foridentifying one or more medical instruments 360 and configuration data352 that associates customized configuration parameters with one or moremedical instruments 360. Data storage device 342 may also includepreoperative image data 354 and/or medical procedure planning data 356.Although data storage device 342 is shown as a single device in FIG. 3,it will be understood that in other embodiments, data storage device 342may be provided as multiple storage devices.

Medical instruments 360 are identifiable by control and processing unit300. Medical instruments 360 may be connected to and controlled bycontrol and processing unit 300, or medical instruments 360 may beoperated or otherwise employed independent of control and processingunit 300. Tracking system 321 may be employed to track one or more ofmedical instruments 360 and spatially register the one or more trackedmedical instruments to an intraoperative reference frame. For example,medical instruments 360 may include tracking markers such as trackingspheres that may be recognizable by a tracking camera 307. In oneexample, the tracking camera 307 may be an infrared (IR) trackingcamera. In another example, as sheath placed over a medical instrument360 may be connected to and controlled by control and processing unit300.

Control and processing unit 300 may also interface with a number ofconfigurable devices, and may intraoperatively reconfigure one or moreof such devices based on configuration parameters obtained fromconfiguration data 352. Examples of devices 320, as shown in FIG. 3,include one or more external imaging devices 322, one or moreillumination devices 324, a robotic arm 305, one or more projectiondevices 328, and one or more displays 205, 211.

Exemplary aspects of the disclosure can be implemented via processor(s)302 and/or memory 304. For example, the functionalities described hereincan be partially implemented via hardware logic in processor 302 andpartially using the instructions stored in memory 304, as one or moreprocessing modules or engines 370. Example processing modules include,but are not limited to, user interface engine 372, tracking module 374,motor controller 376, image processing engine 378, image registrationengine 380, procedure planning engine 382, navigation engine 384, andcontext analysis module 386. While the example processing modules areshown separately in FIG. 3, in one example the processing modules 370may be stored in the memory 304 and the processing modules may becollectively referred to as processing modules 370.

It is to be understood that the system is not intended to be limited tothe components shown in FIG. 3. One or more components of the controland processing system 300 may be provided as an external component ordevice. In one example, navigation module 384 may be provided as anexternal navigation system that is integrated with control andprocessing system 300.

Some embodiments may be implemented using processor 302 withoutadditional instructions stored in memory 304. Some embodiments may beimplemented using the instructions stored in memory 304 for execution byone or more general purpose microprocessors. Thus, the disclosure is notlimited to a specific configuration of hardware and/or software.

While some embodiments can be implemented in fully functioning computersand computer systems, various embodiments are capable of beingdistributed as a computing product in a variety of forms and are capableof being applied regardless of the particular type of machine orcomputer readable media used to actually effect the distribution.

At least some aspects disclosed can be embodied, at least in part, insoftware. That is, the techniques may be carried out in a computersystem or other data processing system in response to its processor,such as a microprocessor, executing sequences of instructions containedin a memory, such as ROM, volatile RAM, non-volatile memory, cache or aremote storage device.

A computer readable storage medium can be used to store software anddata which, when executed by a data processing system, causes the systemto perform various methods. The executable software and data may bestored in various places including for example ROM, volatile RAM,nonvolatile memory and/or cache. Portions of this software and/or datamay be stored in any one of these storage devices.

Examples of computer-readable storage media include, but are not limitedto, recordable and non-recordable type media such as volatile andnon-volatile memory devices, read only memory (ROM), random accessmemory (RAM), flash memory devices, floppy and other removable disks,magnetic disk storage media, optical storage media (e.g., compact discs(CDs), digital versatile disks (DVDs), etc.), among others. Theinstructions may be embodied in digital and analog communication linksfor electrical, optical, acoustical or other forms of propagatedsignals, such as carrier waves, infrared signals, digital signals, andthe like. The storage medium may be the internet cloud, or a computerreadable storage medium such as a disc.

At least some of the methods described herein are capable of beingdistributed in a computer program product comprising a computer readablemedium that bears computer usable instructions for execution by one ormore processors, to perform aspects of the methods described. The mediummay be provided in various forms such as, but not limited to, one ormore diskettes, compact disks, tapes, chips, USB keys, external harddrives, wire-line transmissions, satellite transmissions, internettransmissions or downloads, magnetic and electronic storage media,digital and analog signals, and the like. The computer useableinstructions may also be in various forms, including compiled andnon-compiled code.

According to one aspect of the present application, one purpose of thenavigation system 205, which may include control and processing unit300, is to provide tools to the neurosurgeon that will lead to the mostinformed, least damaging neurosurgical operations. In addition toremoval of brain tumours and intracranial hemorrhages (ICH), thenavigation system 205 can also be applied to a brain biopsy, afunctional/deep-brain stimulation, a catheter/shunt placement procedure,open craniotomies, endonasal/skull-based/ENT, spine procedures, andother parts of the body such as breast biopsies, liver biopsies, etc.While several examples have been provided, aspects of the presentdisclosure may be applied to any suitable medical procedure.

Referring to FIG. 4A, a flow chart is shown illustrating a method 400 ofperforming a port-based surgical procedure using a navigation system,such as the medical navigation system 200 described in relation to FIG.2. At a first block 402, the port-based surgical plan is imported.

Once the plan has been imported into the navigation system at the block402, the patient is affixed into position using a body holdingmechanism. The head position is also confirmed with the patient plan inthe navigation system (block 404), which in one example may beimplemented by the computer or controller forming part of the equipmenttower 201.

Next, registration of the patient is initiated (block 406). The phrase“registration” or “image registration” refers to the process oftransforming different sets of data into one coordinate system. Data mayinclude multiple photographs, data from different sensors, times,depths, or viewpoints. The process of “registration” is used in thepresent application for medical imaging in which images from differentimaging modalities are co-registered. Registration is used in order tobe able to compare or integrate the data obtained from these differentmodalities.

Those skilled in the relevant arts will appreciate that there arenumerous registration techniques available and one or more of thetechniques may be applied to the present example. Non-limiting examplesinclude intensity-based methods that compare intensity patterns inimages via correlation metrics, while feature-based methods findcorrespondence between image features such as points, lines, andcontours. Image registration methods may also be classified according tothe transformation models they use to relate the target image space tothe reference image space. Another classification can be made betweensingle-modality and multi-modality methods. Single-modality methodstypically register images in the same modality acquired by the samescanner or sensor type, for example, a series of magnetic resonance (MR)images may be co-registered, while multi-modality registration methodsare used to register images acquired by different scanner or sensortypes, for example in magnetic resonance imaging (MRI) and positronemission tomography (PET). In the present disclosure, multi-modalityregistration methods may be used in medical imaging of the head and/orbrain as images of a subject are frequently obtained from differentscanners. Examples include registration of brain computerized tomography(CT)/MRI images or PET/CT images for tumor localization, registration ofcontrast-enhanced CT images against non-contrast-enhanced CT images, andregistration of ultrasound and CT.

Referring now to FIG. 4B, a flow chart is shown illustrating a methodinvolved in registration block 406 as outlined in FIG. 4A, in greaterdetail. If the use of fiducial touch points (440) is contemplated, themethod involves first identifying fiducials on images (block 442), thentouching the touch points with a tracked instrument (block 444). Next,the navigation system computes the registration to reference markers(block 446).

Alternately, registration can also be completed by conducting a surfacescan procedure (block 450). The block 450 is presented to show analternative approach, but may not typically be used when using afiducial pointer. First, the face is scanned using a 3D scanner (block452). Next, the face surface is extracted from MR/CT data (block 454).Finally, surfaces are matched to determine registration data points(block 456).

Upon completion of either the fiducial touch points (440) or surfacescan (450) procedures, the data extracted is computed and used toconfirm registration at block 408, shown in FIG. 4A.

Referring back to FIG. 4A, once registration is confirmed (block 408),the patient is draped (block 410). Typically, draping involves coveringthe patient and surrounding areas with a sterile barrier to create andmaintain a sterile field during the surgical procedure. The purpose ofdraping is to eliminate the passage of microorganisms (e.g., bacteria)between non-sterile and sterile areas. At this point, conventionalnavigation systems require that the non-sterile patient reference isreplaced with a sterile patient reference of identical geometry locationand orientation.

Upon completion of draping (block 410), the patient engagement pointsare confirmed (block 412) and then the craniotomy is prepared andplanned (block 414).

Upon completion of the preparation and planning of the craniotomy (block414), the craniotomy is cut and a bone flap is temporarily removed fromthe skull to access the brain (block 416). Registration data is updatedwith the navigation system at this point (block 422).

Next, the engagement within craniotomy and the motion range areconfirmed (block 418). Next, the procedure advances to cutting the duraat the engagement points and identifying the sulcus (block 420).

Thereafter, the cannulation process is initiated (block 424).Cannulation involves inserting a port into the brain, typically along asulci path as identified at 420, along a trajectory plan. Cannulation istypically an iterative process that involves repeating the steps ofaligning the port on engagement and setting the planned trajectory(block 432) and then cannulating to the target depth (block 434) untilthe complete trajectory plan is executed (block 424).

Once cannulation is complete, the surgeon then performs resection (block426) to remove part of the brain and/or tumor of interest. The surgeonthen decannulates (block 428) by removing the port and any trackinginstruments from the brain. Finally, the surgeon closes the dura andcompletes the craniotomy (block 430). Some aspects of FIG. 4A arespecific to port-based surgery, such as portions of blocks 428, 420, and434, but the appropriate portions of these blocks may be skipped orsuitably modified when performing non-port based surgery.

When performing a surgical procedure using a medical navigation system200, as outlined in connection with FIGS. 4A and 4B, the medicalnavigation system 200 must acquire and maintain a reference of thelocation of the tools in use as well as the patient in three dimensional(3D) space. In other words, during a navigated neurosurgery, there needsto be a tracked reference frame that is fixed relative to the patient'sskull. During the registration phase of a navigated neurosurgery (e.g.,the step 406 shown in FIGS. 4A and 4B), a transformation is calculatedthat maps the frame of reference of preoperative MRI or CT imagery tothe physical space of the surgery, specifically the patient's head. Thismay be accomplished by the navigation system 200 tracking locations offiducial markers fixed to the patient's head, relative to the staticpatient reference frame. The patient reference frame is typicallyrigidly attached to the head fixation device, such as a Mayfield clamp.Registration is typically performed before the sterile field has beenestablished (e.g., the step 410 shown in FIG. 4A).

FIG. 5 is a diagram illustrating components of an exemplary surgicalsystem used in port based surgery that is similar to FIG. 2. FIG. 5illustrates a navigation system 200 having an equipment tower 502,tracking system 504, display 506, an intelligent positioning system 508and tracking markers 510 used to tracked instruments or an access port12. Tracking system 504 may also be considered an optical trackingdevice or tracking camera. In FIG. 5, a surgeon 201 is performing atumor resection through a port 12, using an imaging device 512 to viewdown the port at a sufficient magnification to enable enhancedvisibility of the instruments and tissue. The imaging device 512 may bean external scope, videoscope, wide field camera, or an alternate imagecapturing device. The imaging sensor view is depicted on the visualdisplay 506 which surgeon 201 uses for navigating the port's distal endthrough the anatomical region of interest.

An intelligent positioning system 508 comprising an automated arm 514, alifting column 516 and an end effector 518, is placed in proximity topatient 202. Lifting column 516 is connected to a frame of intelligentpositioning system 508. As seen in FIG. 5, the proximal end of automatedmechanical arm 514 (further known as automated arm herein) is connectedto lifting column 516. In other embodiments, automated arm 514 may beconnected to a horizontal beam, which is then either connected tolifting column 516 or directly to frame of the intelligent positioningsystem 508. Automated arm 514 may have multiple joints to enable 5, 6 or7 degrees of freedom.

End effector 518 is attached to the distal end of automated arm 514. Endeffector 518 may accommodate a plurality of instruments or tools thatmay assist surgeon 201 in his procedure. End effector 518 is shown asholding an external scope, however it should be noted that this ismerely an example and alternate devices may be used with the endeffector 518 such as a wide field camera, microscope and OCT (OpticalCoherence Tomography) or other imaging instruments. In another example,multiple end effectors may be attached to the distal end of automatedarm 518, and thus assist the surgeon 201 in switching between multiplemodalities. For example, the surgeon 201 may want the ability to movebetween microscope, and OCT with stand-off optics. In a further example,the ability to attach a second, more accurate, but smaller range endeffector such as a laser based ablation system with micro-control may becontemplated.

The intelligent positioning system 508 receives as input the spatialposition and pose data of the automated arm 514 and target (for examplethe port 12) as determined by tracking system 504 by detection of thetracking markers on the wide field camera on port 12. Further, it shouldbe noted that the tracking markers may be used to track both theautomated arm 514 as well as the end effector 518 either collectively orindependently. It should be noted that a wide field camera 520 is shownin this image and that it is connected to the external scope (e.g.,imaging device 512) and the two imaging devices together are held by theend effector 518. It should additionally be noted that although theseare depicted together for illustration of the diagram that either couldbe utilized independently of the other, for example where an externalvideo scope can be used independently of the wide field camera 520.

Intelligent positioning system 508 computes the desired joint positionsfor automated arm 514 so as to maneuver the end effector 518 mounted onthe automated arm's distal end to a predetermined spatial position andpose relative to the port 12. This redetermined relative spatialposition and pose is termed the “Zero Position” where the sensor ofimaging device 512 and port 12 are axially aligned.

Further, the intelligent positioning system 508, optical tracking device504, automated arm 514, and tracking markers 510 form a feedback loop.This feedback loop works to keep the distal end of the port 12 (locatedinside the brain) in constant view and focus of the end effector 518given that it is an imaging device as the port position may bedynamically manipulated by the surgeon during the procedure. Intelligentpositioning system 508 may also include a foot pedal for use by thesurgeon 201 to align the end effector 518 (i.e., holding a videoscope)of automated arm 514 with the port 12.

Referring to FIG. 6, a conventional end effector 518 is shown attachedto automated arm 514. The end effector 518 includes a handle 602 and ascope clamp 604. The scope clamp 604 holds imaging device 512. The endeffector also has wide field camera 520 attached thereto.

Referring now to FIG. 7, a perspective drawing is shown illustrating anend effector 700 according to aspects of the present description. FIG. 8is another perspective drawing showing the end effector 700 of FIG. 7from a different viewpoint. FIG. 9 is another perspective drawingshowing the end effector 700 of FIG. 7 holding a scope and camera. FIG.10 is another perspective drawing from a different perspective showingthe end effector 700 of FIG. 9 holding the scope and camera andconnected to a positioning arm of a positioning device. FIGS. 7-10 willnow be discussed concurrently.

The end effector 700 may connect to a positioning arm, such as theautomated arm 514 of a medical navigation system 200. The end effector700 has a mating component 702 for connecting to an output flange of thepositioning arm. The end effector 700 further has a handle portion 704having a first end 706 and a second end 708. The first end 706 extendsfrom the mating component 702. The handle portion 704 includes a cablecut-out 710 at the first end 706 for receiving and managing cables. Acamera mount 712 is connected to the second end 708 of the handleportion 704.

The end effector 700 further has a mechanical interface 714 located atthe second end 708 of the handle portion 704. A scope clamp arm 716 maybe connected to the mechanical interface 714. The scope clamp arm 716may have a fastening ring 718 for securing a scope, such as avideoscope. In one example, the mechanical interface 714 may include adovetail interface with the scope clamp arm 716 slideably engagedtherein and secured by a screw 720. In one example, the screw 720 may bea thumbscrew for easily attaching and detaching the scope clamp arm 716.The scope clamp arm 716 may be connectable to a scope 722 (FIGS. 9 and10) for clamping the scope 722 in position adjacent the camera mount 712using the fastening ring 718. The scope 722 may further have anilluminator 724 (FIGS. 9 and 10) at a distal end of the scope 722 thatis connectable to at least one light pipe 726 (FIGS. 9 and 10). In oneexample, two light pipes 726 may be used. The light pipes 726 may havecables 728 (FIGS. 9 and 10) leading thereto. In one example, the cables728 may be fiber optic cables that conduct electromagnetic energy in thevisible spectrum.

In one example, the scope 722 may be an exoscope and a camera 730 ismountable on a proximal end of the exoscope. In one example, the camera730 may be a surgical site camera for displaying a magnified image of asurgical site. One or more cables 732 leading to the camera 730 and thecables 728 leading to at least one light pipe may be positioned throughthe cable cut-out 710, therefore managing the cables in the vicinity ofthe end effector 700 and avoid clutter in the workspace of the surgeon.

The scope clamp arm 716 may further having a tracking marker frame 734attached thereto. The tracking marker frame 734 has a coupling forconnecting to a tracking marker 736 (FIG. 10). The tracking marker maybe any of passive reflective tracking spheres, active infrared (IR)markers, active light emitting diodes (LEDs), or a graphical pattern. Inone example, there are at least three couplings on the frame 734connected to at least three respective tracking markers 736. In oneexample, there may be four passive reflective tracking spheres coupledto the frame 734. While some specific examples of the type and number oftracking markers 736 have been given, any suitable tracking marker typeand configuration may be used to meet the design criteria of aparticular application.

In one example, the camera mount 712 connected to the second end 708 ofthe handle portion 704 has a camera 738 (FIGS. 9 and 10) mountedthereon. The camera 738 may also have a cable (not shown) connected tothe camera 738 that may also extend through the cable cut-out 710. Inone example, the camera 738 may be a situational awareness camera thatshows a macroscopic view of the medical or surgical workspace on adisplay, such as a display 506, such that the surgeon can see what isgoing on in the vicinity of the surgical area of interest without havingto divert his or her eyes from the display (or displays) 506 where themagnified view of the surgical area of interest from the camera 730 isbeing displayed.

In one example, the mating component 702 connects to the output flangeof the positioning arm with a dowel pin 748 (FIG. 8) for localizationand is mechanically secured with at least one screw 742. In one example,the positioning arm 514 may use a standard ISO 9409-1-50-4-M6 tooloutput flange. The flange and a dowel pin 748 may be used forlocalization, while four M6 screws may secure the mating component 702to the positioning arm. In one example, the mating component may alsoinclude an 8-pin M8 connector to a Lumberg RSMEDG8 connector on thepositioning arm. While a specific example is provided of how the matingcomponent 702 may connect to the positioning arm 514 both mechanicallyand electrically, any suitable connection may be used to meet the designcriteria of a particular application.

The end effector 700 may further have a trigger mechanism 744 locatedadjacent the mating component 702 for mechanically communicating withthe positioning arm. A trigger 746 may emanate from the triggermechanism 744. Actuation of the trigger 746 may place the positioningarm 514 into compliant mode providing for manual positioning of thepositioning arm 514 using the handle portion 704. In one example, thetrigger mechanism 744 may include a switch that communicateselectrically with the control and processing unit 300.

In one example, the end effector 700 may be designed to be as thin aspossible so that the end effector does not obstruct the view of asurgeon using the end effector 700. In one example, the triggermechanism 744, the handle 704, the first camera 730, the second camera738, the scope 722, the scope clamp arm 716, and the tracking markerframe 734 all have respective center lines that are substantiallyaligned resulting in a thin profile that reduces obstruction of the viewof a surgeon using the end effector 700 in the medical navigation system200.

The end effector 700 may also have a force-moment sensor (not shown),which in one example could be positioned between the end-effector 700and the positioning arm 514. In one example, the force-moment sensorcould be cylindrical, similar to the mating component, and may form partof the end-effector (e.g., may be positioned just above the matingcomponent 702). The force-moment sensor may provide for a force-momentaccommodation (FMA) mode, where the controller receives a signal fromthe force moment sensor and moves the positioning arm in response toforces applied to the end effector 700 and sensed by the force-momentsensor.

In one example, the positioning arm 514 and the end effector 700including the mating component 702 and the handle portion 704 aredraped, whereas the scope 722, the illuminator 724, the fastening ring718, and the tracking marker frame 734 are made of a material that issterilizable and will not be draped. The scope clamp arm 716 mayprotrude from the drape and also be made of a sterilizable material.

The end effector 700 may aim to meet a number of objectives, includingholding the exoscope 722, providing the trigger 746 and triggermechanism 744 to place the positioning arm 514 into manual positioningmode when the trigger 746 is depressed, allowing for easy access to anybuttons on the camera 730 when using the end effector 700, allowing forthe scope 722 to be quickly and easily replaced, providing a handle 704to handle the positioning arm 514 to which the end effector 700 isattached, keeping the light pipes 726 and all cables 728, 732 neatlymanaged and out of the workspace of the surgeon and away from the handle704, providing for appropriate placement of tracking markers 736 withinfield of view of the tracking camera 504, maintaining the scope 722,cameras 730, 738, and tracking markers 736 outside of the sterile drapeso that the drape does not interfere with optics while the remainingcomponents may be draped, and maintaining a clear line of site to thedisplay 506.

The specific embodiments described above have been shown by way ofexample, and it should be understood that these embodiments may besusceptible to various modifications and alternative forms. It should befurther understood that the claims are not intended to be limited to theparticular forms disclosed, but rather to cover all modifications,equivalents, and alternatives falling within the spirit and scope ofthis disclosure.

We claim:
 1. An end effector for connecting to a multi-jointed roboticarm of a positioning device of a medical navigation system, the endeffector comprising: a mating component for connecting to an outputflange at a distal end of the multi-jointed robotic arm; a handleportion having a first end and a second end, the first end extendingfrom the mating component, the handle portion including a cable cut-outat the first end; a camera mount connected to the second end of thehandle portion; a mechanical interface located at the second end of thehandle portion; a scope clamp arm connected to the mechanical interfacefor clamping a scope having a first camera; a trigger mechanism locatedadjacent the mating component for communicating with the multi-jointedrobotic arm; and a trigger emanating from the trigger mechanism, atleast one of the trigger or trigger mechanism being configured to bemanually held, the trigger being configured to be manually actuated;wherein the scope clamp is connectable to a scope with a fastening ringfor clamping a scope in position adjacent the camera mount, the scopehaving an illuminator at a distal end of the scope that is connectableto at least one light pipe; and wherein manual actuation of the triggerplaces the multi-jointed robotic arm into compliant mode in which manualpositioning of the joints of the multi-jointed robotic arm is enabled,wherein manual positioning of the joints is facilitated using the handleportion to directly and physically manually manipulate the end effectorand the multi-jointed robotic arm to which the end effector isconnected.
 2. The end effector according to claim 1, wherein the scopeincludes an exoscope and the first camera is mountable on a proximal endof the exoscope.
 3. The end effector according to claim 1, wherein thefirst camera is a surgical site camera for displaying a magnified imageof a surgical site, cables leading to the first camera and the at leastone light pipe being positionable through the cable cut-out.
 4. Amedical navigation system, comprising: a positioning device having amulti-jointed robotic arm with an output flange at a distal end of themulti-jointed robotic arm; a controller at least electrically coupled tothe positioning device, the controller having a processor coupled to amemory and a display; and an end effector connected to the distal end ofthe multi-jointed robotic arm of the positioning device, the endeffector comprising: a mating component connected to the output flange;a handle portion having a first end and a second end, the first endextending from the mating component, the handle portion including acable cut-out at the first end; a camera mount connected to the secondend of the handle portion; a mechanical interface located at the secondend of the handle portion; a scope clamp arm connected to the mechanicalinterface for clamping a scope having a first camera; a triggermechanism located adjacent the mating component for communicating withthe multi-jointed robotic arm; and a trigger emanating from the triggermechanism, at least one of the trigger or trigger mechanism beingconfigured to be manually held, the trigger being configured to bemanually actuated; wherein the scope clamp arm is connected to a scopewith a fastening ring for clamping a scope in position adjacent thecamera mount, the scope having an illuminator at a distal end of thescope that is connectable to at least one light pipe; and wherein manualactuation of the trigger places the multi-jointed robotic arm intocompliant mode in which manual positioning of the joints of themulti-jointed robotic arm is enabled, wherein manual positioning of thejoints is facilitated using the handle portion to directly andphysically manually manipulate the end effector and the multi-jointedrobotic arm to which the end effector is connected.
 5. The medicalnavigation system according to claim 4, wherein the scope includes anexoscope and the first camera is mountable on a proximal end of theexoscope.
 6. The medical navigation system according to claim 4, whereinthe first camera is a surgical site camera for displaying a magnifiedimage of a surgical site on the display, cables leading to the firstcamera and the at least one light pipe being positionable through thecable cut-out.
 7. An end effector for connecting to a multi-jointedrobotic arm of a positioning device of a medical navigation system, theend effector comprising: a mating component for connecting to an outputflange at a distal end of the multi-jointed robotic arm; a handleportion having a first end and a second end, the first end extendingfrom the mating component, the handle portion including a cable cut-outat the first end; a camera mount connected to the second end of thehandle portion; a trigger mechanism located adjacent the matingcomponent for communicating with the multi-jointed robotic arm; and atrigger emanating from the trigger mechanism, at least one of thetrigger or trigger mechanism being configured to be manually held, thetrigger being configured to be manually actuated; wherein manualactuation of the trigger places the multi-jointed robotic arm intocompliant mode in which manual positioning of the joints of themulti-jointed robotic arm is enabled, wherein manual positioning of thejoints is facilitated using the handle portion to directly andphysically manually manipulate the end effector and the multi-jointedrobotic arm to which the end effector is connected.
 8. The end effectoraccording to claim 1, further comprising a tracking marker frame forcoupling to at least one tracking marker.
 9. The medical navigationsystem according to claim 4, wherein the end effector further comprisesa tracking marker frame for coupling to at least one tracking marker.10. The end effector according to claim 8, wherein the triggermechanism, the handle, the first camera, the second camera, the scope,the scope clamp arm, and the tracking marker frame all have respectivecenter lines that are substantially aligned resulting in a thin profilethat reduces visual obstruction of a surgeon using the end effector inthe medical navigation system.
 11. The medical navigation systemaccording to claim 9, wherein the trigger mechanism, the handle, thefirst camera, the second camera, the scope, the scope clamp arm, and thetracking marker frame all have respective center lines that aresubstantially aligned resulting in a thin profile that reducesobstruction of the view of a surgeon using the end effector in themedical navigation system.